Behavioral Health Enterprise Risk Management (ERM) Legal & Regulatory Patient Safety/Clinical Care Quality

Chaperone Roles in Risk Management

Health care providers and organizations often struggle with using chaperones. Conversations revolve around issues of duty, choice, safety, budgetary constraints, as well as establishing an effective process. Here is some guidance to help mitigate potential risk exposures.

An appropriate physical examination is an essential component of the patient visit, with the scope of an exam depending upon the reason for the visit and diagnostic needs. Careful communication about the purpose and scope of the physical examination should be provided in a way that is easily understood by the patient. The provider-patient relationship is damaged when there is misunderstanding and confusion regarding professional roles and behaviors. This can lead to complaints as well as allegations of sexual misconduct or abuse.

Physical Examination Chaperones

Among the measures recommended to lessen the risk of complaints alleging misconduct is to use a chaperone during the patient physical examination. There is some controversy in discussions about the use of chaperones, as well as conversations about standard processes, policy guideline, decision making and logic. Using chaperones in every case can be unrealistic. Also, while some patients may feel a chaperone provides reassurance and advocacy of the professional character of an exam, other patients might perceive a chaperone as an act of mistrust and suspicion by the provider. Having a chaperone may not be appropriate in all circumstances, but it is a discussion that needs to occur between the provider and the patient. In order to make an informed decision about the use of a chaperone, every provider should weigh the risks, benefits and alternatives for each patient encounter.

Best Practices Recommendations

  • All requests from a patient for a chaperone should be discussed and addressed regardless of the provider’s sex.
  • All intimate exams should have a process where a chaperone is always available, if needed. This includes exams of the breasts, pelvic region and rectal area.
  • Health care organizations should have signage offering patients the option of a chaperone.
  • Exams should be performed with only the necessary amount of physical contact needed to obtain information for diagnosis and treatment.
  • Gloves should be worn during all intimate physical exams.
  • A separate opportunity for private discussions between the patient and provider should be made available after the exam, if a chaperone is used.
  • The patient should be able to choose whether or not to have a family member or friend present during the exam. However, authorized health care team members should serve as chaperones. Family members or friends of the patient should not be considered chaperones.
  • Patients should be provided private time to undress and prepare for the exam. Do not stay in the room during this time or assist the patient with removing any clothing, unless medically necessary and authorized by the patient. If so, there should be a witness present on behalf of the provider.
  • Avoid making comments or remarks unrelated to the medical necessity of the physical exam. For example, commenting on a tattoo, piercing, undergarment or a tan should never be done.
  • Forgo the exam until a later time if a chaperone cannot be provided at the time. Discuss the risks, benefits, and alternatives with the patient.
  • Document the medical record thoroughly. Any offer or declination of a chaperone should be clearly reflected in the medical record.

The above best practice tips should be implemented whenever possible. Not all scenarios fit within the best practices, but should always be addressed by risk managers with appropriate organizational and medical provider leaders. In the references below are supporting resources to assist is assessing potential exposures, which might require chaperones.

REFERENCES

Curry, Edward S., MD, (2011) “Policy Statement—Use of Chaperones During the Physical Examination of the Pediatric Patient.” PEDIATRICS. 127, 5. Retrieved December 2018.

Harris, Rachel, (May 2016). Intimate examinations and chaperone policy. Society of Radiographers. Retrieved March 2019.

Sexual misconduct, (2007) ACOG Committee Opinion No. 373. American College of Obstetricians and Gynecologists. Obstet Gynecol. 110:441–4. Retrieved March 2019.

Use of Chaperones, Code of Medical Ethics Opinion 1.2.4. American Medical Association. Retrieved March 2019.

Authors Leigh Ann Yates, AIC, MBA, CPHRM, FASHRM, is director of Risk Management and Insurance, and Stephanie Nadasi, RN, MHSA, CPHRM, is a risk management specialist at The George Washington Medical Faculty Associates, Washington, D.C.

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